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Davis, a medical sociologist in the Department of Women's Studies at the University of Utrecht in the Netherlands, provides an extraordinary insight into a contemporary dilemma. Her book evaluates the situation both of women who choose cosmetic surgery and medical and sociology scholars who attempt to understand the forces that determine that choice.

The outcome of surgery is described through the voices of some of the same women first interviewed before surgery and again 1 year later. Davis' scholarly investigation began from the perspective of a feminist scholar enraged at "the horrors being perpetrated on women's bodies by the medical system" (p. 1).

The systematic exploration, which Davis pursued, led her to a more moderate conclusion. She relays her own startled reaction as her feminist colleagues began confiding in her that they were seeking cosmetic surgery, in spite of former vocal opposition to it, and how this dialogue led to her decision to investigate this medical practice more deeply.

Spanning a period of several years, her evaluation involved three empirical studies: an exploratory study, a clinical study, and field work. She investigates cosmetic surgery, sequentially exploring the perspectives of all involved covering a number of topics.

1. What women themselves have to say as they approach the medical establishment seeking surgery; that they seek surgery because they suffer from "being abnormal" and have this feeling reinforced by comments and experiences in their relationships with others. For example:

The problems were different—facial blemishes, sagging breasts, saddlebag thighs—but the language was remarkably similar. Each woman emphasized how ugly, awful, unaesthetic, or even dirty her particular bodily defect was. The vocabulary used vividly displayed the extent of her distress. Each depicted her body (or some part of it) as something which she could not possibly accept. Hated body parts were dissociated from the rest of her body as objects "those things," "mountains of fat," "sagging knockers." They were described as pieces of flesh which had been imposed upon her inanimate and yet acting against her. They became something which each woman wanted to, literally, cut out of her life. (p. 74)

2. How the medical profession in the Netherlands attempts to evaluate the appropriateness of the surgical candidate against limited economic resources in a socialized medicine setting. Davis reveals that "even socialized medicine, with its discourse of need cannot solve the problem of whether and under what circumstances the surgical alteration of the body for aesthetic reasons can be justified."

3. The actual and almost universally humiliating experience that women have as they encounter the mostly male medical establishment. As women attempt to negotiate effectively to establish adequate need, based on their abnormal appearance, they are forced to expose their "abnormality" to the examination of strangers as they convince them of the suffering they have endured which led them to seek surgical alteration.

4. The lack of objective criteria that can be applied to what constitutes an abnormality. Not only has the Dutch medical system been unable to establish any objective criteria, Davis also finds that she can't either. Davis learns to her surprise that she is unable to predict what surgical alteration (nose? breast?) women are seeking as she observes successive applicants engaged with the medical examiner.

As an accepted observer in the medical examining room, she has the opportunity to watch a series—up to 15 evaluations in a morning—and finds that the "abnormality" which brings the patient to seek surgical alteration is not obvious before the patient begins to articulate why she is seeking insurance approvals.

5. The reactions of family members, who in this sample have often not wanted the candidate to seek surgery and may support or discourage the search for surgery. Poignant stories are told of women who always felt themselves the unloved child, the ugly duckling, and who win the approval for surgical alteration, only to find themselves still the unloved one and still not considered attractive by others.

Other stories—of women who long felt their breast size too small—produce jubilation at the change when the surgery went well and the husband who had objected to the surgery, now loved the outcome. Davis did not supply frequencies so the reader recognizes a variety of outcomes without knowing their likelihood.

6. The surgical experience itself. The surgical patient experiences physical pain that is often severe and of long duration, undergoes a complex postoperative recovery, and achieves variable outcomes, which include improvements as well as permanent disfigurement leaving the patient much worse than before.

7. The judgment of the recently cosmetically altered women are almost always positive 1 year after their surgeries. Even in the face of permanent disfigurement induced by surgery, the patients overwhelmingly conclude that they are glad they did it. But stories are told that suggest this positive conclusion is due to having taken action to improve one's life rather than having a changed appearance.

The stories that women tell vary, in their 3–6 hr postsurgical interview, as they have time to consider, reevaluate,and reconsider their overall experience. Often at the end of the interview, as the postsurgical patient is explaining her story for the fourth or fifth time, Davis comments that the patient is using the interview as a way of coming to terms with her own experience:

Diana gradually modifies her original assessment: "You tend to think that people react to you because of your appearance. Well, I guess it does play a role... in my case it just didn't make any difference. No difference at all. I mean, whether people liked me or didn't like me. Or whether I liked them. That all just stayed the same. Absolutely nothing changed. The only thing that changed were the superficial contacts. On the train, in the bus, on the street. That's all." (pp. 110–111)

The overall goal women have in seeking surgery appears consistent in spite of the variety of procedures undertaken.To be ordinary rather than unattractive. And the stories Davis hears leads her to conclude that women overwhelmingly meet that goal in their surgical experience and postsurgical assessment.

8. The conflicting reactions of the various feminist factions as expressed at conferences and through published essays. The analyses of these form the final chapter of the book. Davis concludes with a rejection of the "politically correct" feminist position against surgery and states:

"Cosmetic surgery is not about beauty, but about identity. For a woman who feels trapped in a body which does not fit her sense of who she is, cosmetic surgery becomes away to renegotiate identity through her body.

Cosmetic surgery is about morality. For a woman whose suffering has gone beyond a certain point, cosmetic surgery can become a matter of justice—the only fair thing to do. (p. 163)"

As any act of scholarship should do, this book generates more questions than the work was designed to address. What subsequent investigations could add to her presentation are actual data of incidence and frequencies of the phenomena that are explained.

How large is the risk for a woman undergoing the breast augmentation (e.g.,when they need to reposition the breasts to correct surgically induced asymmetry or remove hardened or leaking implants and fibrous scar tissue)? What percentage of the time does the surgical implant procedure cause the pathologies described in the text? How many women who express satisfaction at the 1-year postoperative interval would still feel satisfied with their decision at the 5-year interval?

Women who undergo elective hysterectomy (click here for more) for benign conditions usually report satisfaction at 1 year but with increasing time thereafter discover side effects that change their view (Cutler, 1990). Are there alternative treatments that might equally produce equal benefits without the risks and pain of surgery? Are these outcomes different for surgical choices geared to reversing visible signs of aging versus choices geared to correcting a life-long view of the self as abnormal?

This work represents a gentle and respectful exploration. It is an extremely courteous inquiry into the subject of why women seek the surgery, what they have to say about their experiences, and how others who make judgments of these women react.

It offers the reader a rather unique insight, gathered from hundreds of hours of active and nonpejorative listening to what people will say, when given hours to review their experience, to repeat their story often three or four times at the one interview and, in doing so, make sense of their own complex and evolving conclusions about these experiences.